Multi-State analysis of secondary prevention of stroke in Northern Ghana

Abstract

We obtained secondary data from the medical unit of the Tamale Teaching Hospital in which stroke patients were on rehabilitation. The purpose of the study is to develop an illness-to-death model that will enable us to observe the transition rates of patients during rehabilitation at some discrete points in time. A review of literature on stroke in many research works revealed that none of the articles estimated the probabilities of transition at different level of the disease. We employed Continuous Time Markov Model (CTMC) in Multi-state Models (MSM) to observe the transition rates of the patients at two equal monthly intervals for two years. Results from the transition analysis indicated that patients with mild stroke will remain in this state for about 10 months before recovery and will never become severe if the patient adheres to treatment. While old and older age groups have some chance of transiting to a less severe state and similar probabilities of transiting from mild to a more severe state, the study also suggests that the recovery rate is fast in higher states than in lower states. It must be noticed that patients spent more time at state 2, followed by state three (3), and less time at state 4. This suggests that patients with mild stroke longer at mild state than other states and hence they need to continue to adhere to treatment to gain total recovery. We therefore recommend that; patients who transit to mild state should be advised by medical officers to continue to adhere to treatment to speed up total recovery